Health Care Compliance
Health care compliance is a complex, ever-evolving landscape crucial to delivering on your organization’s mission. Complying with applicable laws, regulations, and standards that govern the health care industry is an ongoing challenge that directly impacts patient privacy, access to care, data security, bill and coding accuracy, and quality care.
Effective internal audit and compliance is foundational to risk management and can help establish a proactive approach to aligning, meeting, and monitoring legal, ethical, and professional standards. Assess your program’s maturity and risk areas while also developing—and implementing—a comprehensive, well-integrated compliance program with support and guidance from our experienced professionals.
Explore how our comprehensive health care compliance services can elevate your organization’s ability to mitigate risk, respond to changing regulations, and keep your organization moving upward.
Create a Robust Compliance Ecosystem
Maintaining compliance has a significant impact on your organization’s reputation, funding, and quality of service. Drive compliance success with comprehensive assessments services designed to improve accuracy, uncover opportunities, and build a sustainable compliance infrastructure.
Compliance Program Assessments
Elevate your program’s maturity rating and communicate your level of compliance with our comprehensive program assessment that includes evaluating each of the OIG’s seven elements of effective compliance programming:
- Compliance leadership and oversight
- Written policies and procedures
- Training and education
- Establishing effective lines of communication
- Enforcing standards
- Risk assessment, audit, and monitoring
- Responding to detected offenses and developing corrective action initiatives
Additional projects can include:
- Full compliance program assessment
- Targeted assessment of key compliance program areas
Compliance Risk Assessment
A compliance focused risk assessment is pivotal for determining where an organization should focus its compliance efforts. Clarify your compliance efforts through our compliance risk assessment services. Our professionals work with stakeholders to identify key areas of concern for reputational, financial, and regulatory compliance and develop an actionable plan for the upcoming year.
Risk assessments include:
- Survey of select workforce members
- Individual sessions
- Group sessions
Compliance Audit and Monitoring
Mitigating risk is an ongoing challenge for many health care organizations. Leveraging a sustainable audit and monitoring program can help manage risk and identify specific risk areas to address potential issues before they become a problem.
Move beyond conventional, all-purpose audits to a customized audit and monitoring approach that can help your organization meet and maintain its compliance requirements while avoiding risks. Our experienced professionals can help formulate action plans related to special investigations and overpayment refunds, including how to score or evaluate the results.
In addition, we can help you design audit programs to support quality assurance programs related to coders and other billing staff.
Payer Audit and Investigation Reviews
Payer audits and investigations are time consuming, disruptive, and potentially costly. Improve the process with guidance and insight from a payer audit and investigation review.
Our professionals review and analyze your organization’s payer audits and investigations results to verify accuracy, improve incident reporting, and identify process improvements.
Our process includes:
- Review of payers’ findings
- Analysis of a comparative period
- Interview providers and staff to ascertain facts related to the inquiry
- Validate extrapolations
- Prepare written reports of findings
Corporate Integrity Agreements
Corporate integrity agreements are multifaceted and complex. Improve your experience and outcomes with advisors experienced with the various phases of corporate integrity agreements, including:
- Help implementing components of an agreement, including providing training and interim Compliance Officer services
- Help with developing corrective action plans to address any deficiencies noted during the annual review
HIPAA Privacy Assessment
Complying with the Health Insurance Portability and Accountability Act (HIPAA) and privacy with Protected Health Information (PHI) is a critical component to every health care organization’s compliance landscape.
Strengthen your organization’s compliance processes with our HIPAA Privacy Assessment that verifies key steps in the HIPAA compliance process.
Compliance Program Assessments
Elevate your program’s maturity rating and communicate your level of compliance with our comprehensive program assessment that includes evaluating each of the OIG’s seven elements of effective compliance programming:
- Compliance leadership and oversight
- Written policies and procedures
- Training and education
- Establishing effective lines of communication
- Enforcing standards
- Risk assessment, audit, and monitoring
- Responding to detected offenses and developing corrective action initiatives
Additional projects can include:
- Full compliance program assessment
- Targeted assessment of key compliance program areas
Compliance Risk Assessment
A compliance focused risk assessment is pivotal for determining where an organization should focus its compliance efforts. Clarify your compliance efforts through our compliance risk assessment services. Our professionals work with stakeholders to identify key areas of concern for reputational, financial, and regulatory compliance and develop an actionable plan for the upcoming year.
Risk assessments include:
- Survey of select workforce members
- Individual sessions
- Group sessions
Compliance Audit and Monitoring
Mitigating risk is an ongoing challenge for many health care organizations. Leveraging a sustainable audit and monitoring program can help manage risk and identify specific risk areas to address potential issues before they become a problem.
Move beyond conventional, all-purpose audits to a customized audit and monitoring approach that can help your organization meet and maintain its compliance requirements while avoiding risks. Our experienced professionals can help formulate action plans related to special investigations and overpayment refunds, including how to score or evaluate the results.
In addition, we can help you design audit programs to support quality assurance programs related to coders and other billing staff.
Payer Audit and Investigation Reviews
Payer audits and investigations are time consuming, disruptive, and potentially costly. Improve the process with guidance and insight from a payer audit and investigation review.
Our professionals review and analyze your organization’s payer audits and investigations results to verify accuracy, improve incident reporting, and identify process improvements.
Our process includes:
- Review of payers’ findings
- Analysis of a comparative period
- Interview providers and staff to ascertain facts related to the inquiry
- Validate extrapolations
- Prepare written reports of findings
Corporate Integrity Agreements
Corporate integrity agreements are multifaceted and complex. Improve your experience and outcomes with advisors experienced with the various phases of corporate integrity agreements, including:
- Help implementing components of an agreement, including providing training and interim Compliance Officer services
- Help with developing corrective action plans to address any deficiencies noted during the annual review
HIPAA Privacy Assessment
Complying with the Health Insurance Portability and Accountability Act (HIPAA) and privacy with Protected Health Information (PHI) is a critical component to every health care organization’s compliance landscape.
Strengthen your organization’s compliance processes with our HIPAA Privacy Assessment that verifies key steps in the HIPAA compliance process.
How We Work with You
Although each project is unique, compliance assessments and reviews follow a comprehensive yet incremental process that allows technical and non-technical elements to be addressed in tandem.
Experienced Health Care and Compliance Professionals
Deeply immersed within the health care industry, our professionals have extensive knowledge of the nuanced operations of health care compliance programs. Our collaborative approach takes the time to understand the specifics of your organization’s needs and strategically develop unique solutions contextualized among greater industry trends and activity.
We don’t simply provide templates or toolkits; we proactively determine appropriate solutions that help build foundations for long-term success—so you’re prepared to embrace and stay ahead of change. Our team of highly specialized health care consultants work with you to address compliance challenges and develop a robust infrastructure that includes policies and procedures, ongoing training, and the use of technology to streamline compliance efforts.
Our one-firm approach allows your organization to tap into the full resources of our firm, integrating guidance and solutions related to other integral support areas including finance, tax, and audit concerns, as well as revenue cycle services, Independent Review Organization services, and technology guidance.
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